Provider Demographics
NPI:1861675738
Name:KING, WILLIAM WAYMON III (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WAYMON
Last Name:KING
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:WAYNE
Other - Middle Name:
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 2168
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37024-2168
Mailing Address - Country:US
Mailing Address - Phone:404-915-9183
Mailing Address - Fax:615-730-6496
Practice Address - Street 1:2170 BIG SPRING RD
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-3896
Practice Address - Country:US
Practice Address - Phone:931-692-4181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20391223G0001X
TNDS00000076921223G0001X
GADN0100901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice